Int. J. of Health Serv. Res. and Policy (2020) 5(2):111-122

111

INTERNATIONAL

ENGINEERING

SCIENCE AND

EDUCATION GROUP

International Journal of Health Services

Research and Policy www.dergipark.org.tr/ijhsrp

e-ISSN: 2602-3482

IJHSRP Research Article

THE EFFECT OF TWO DIFFERENT METHODS IN TERMS OF MALPRACTICE: A

RANDOMIZED CONTROLLED STUDY

Cagla YIGITBAS1 Fadime USTUNER TOP2 Aliye BULUT3

1Giresun University, Faculty of Health Sciences, Department of Midwifery, Giresun/Turkey

2Giresun University, Faculty of Health Sciences, Department of Nursing, Giresun/Turkey

3Gaziantep Islamic Science and Technology University, Faculty of Health Sciences, Department of

Midwifery, Gaziantep/Turkey

Corresponding author; caglayigitbas@hotmail.com

Abstract: The objective is to research the face-to-face method of education and the educational methods

through information technology in the tendency and approach to medical errors and whether some

characteristics create a difference in both these situations. It is randomized controlled intervention

research with a pretest-posttest design. A power analysis was carried out and 60 individuals were

included in the sampling. Pretesting was conducted through data collection tools before hospital

implementations were commenced. The required interventions were conducted after hospital

implementations were commenced. No interventions were made on the control group. The individual

identificatory characteristics of the participants comprised the independent variables; the Medical

Error Tendency Scale for Nurses (METSN) and Medical Error Attitude Scale (MEAS) comprised the

dependent variables. The analyses were implemented via SPSS-22 program, and p<0.05 was regarded

as the significance level. The mean age of the participants was 22.02 ± 3.33 (20-41). The pretest score

from METSN was 217.51 ± 15.14, the posttest score from METSN was 220.18 ± 15.39, the pretest score

from MEAS was 62.71 ± 5.24, and the posttest score from MEAS was 64.21 ± 5.18 in terms of Mean ±

SD scores. No difference was found in the pretest and posttest scores from METSN and MEAS of the

variables of age group, gender, income, the place lived in over a long period, whether the job was

selected in accordance with one's own preference, satisfaction with job selection. A moderately positive

correlation was found between the pretest and posttest scores from METSN and MEAS. Type of

education received and some of the socio-demographic characteristics researched do not constitute any

difference in terms of the tendency and attitude to medical error and malpractice; nevertheless, the

posttest scores of the intervention groups were high. Evaluation of whether clinical skills make a

difference may be recommended.

Keywords: Medical error, malpractice, tendency and attitude, face-to-face education, via information

technology education

Received: May 18, 2020 Accepted: June 30, 2020

Int. J. of Health Serv. Res. and Policy (2020) 5(2):111-122

112

1. Introduction

''Medical Error (ME)'' or ''Malpractice (M)'' as expressed in another definition used in the

literature, which was first recorded in 1671 and commonly used as of the second half of the 20th century

was derived from ''Male'' and ''Praxis'' words in Latin, and it means ''erroneous practice" [1]. The Joint

Commission on Accreditation of Healthcare Organizations has defined this situation as ''harm done to

the patient as a result of the fact that a professional providing health service has committed an

inappropriate and unethical behavior, and s/he has acted insufficiently and negligently in professional

implementations'' [2]. A medical side effect occurs that prolongs the length of hospital stay and / or

causes an additional problem during discharge from hospital in %3.7 of the patients hospitalized and

that harms them as a result. %58.0 of these side effects are due to (ME) / (M). ME / M is not only the

erroneous, deficient implementation of an intervention, treatment, or practice, but it also denotes a

procedure that wasn't conducted although it should have been, or that was conducted although it

shouldn't have been [3]. Nursing is a job with substantial workload arising from the effects of many

negative factors emanating from the work environment. Reasons such as excessive workload, emotional

stress experienced due to patients' problems, working with patients in need of intensive care, and in the

process of dying and working in shifts in particular in nursing make working conditions harder. Working

under difficult conditions may increase the ME / M ratio of nurses during their nursing interventions

[4]. According to a study specified in the national literature, medication errors that endanger patient

safety are generally related to nurses [5-8].

ME / M causes prolongation of the treatment, additional costs, and emotional damage emanating

from the treatment of new disabilities or complications [9]. In addition, ME / M brings with itself the

loss of the morale and motivation of health professionals, distrust in patients towards health staff, and

dissatisfaction in society with the health system. It has been stated in the ''report on patient safety'' of the

WHO that patients in various countries, including Australia, Canada, England, Germany, and New

Zealand experience ME / M and undesirable events. The frequency of unexpected ME / M is between

%3.2 and %16.6 in these countries. One in every ten patients is seriously affected by errors committed

during treatment; %14.0 of these errors result in death, and %70.0 of them result in various disabilities

[10]. The training provided to the health staff is emphasized to have decreased ME / M in the literature

[11,12]. Training on health can be provided today in many ways such as the traditional method or

through information technology and information technology adventure has gained impetus, symmetry,

mobility, and globality through new media technologies making the headlines since the 1960s [13].

Information technology can be defined as the use (obtaining) of modern knowledge in the electronic

environment, which encompasses access, storing, data processing, and transfer or delivery [14]. Within

this context, this study aims to compare whether face-to-face education method, preferred as an

educational method since very old times and the method of information technology creates a difference

in bringing ME / M tendency and attitude to desired levels. Whether some identificatory characteristics

also make a difference in ME / M tendency and attitude will be determined through this study.

2. 2. Materials and Methods

2.1. Design

The study is intervention research with randomized control encompassing comparison of pretest

and posttest. It is oriented towards the comparison of the pre-intervention awareness level of nursing

Int. J. of Health Serv. Res. and Policy (2020) 5(2):111-122

113

students in ME / M tendency and attitude with their post-intervention awareness level. The participants

were randomly selected in this factually experimental design [15] defined as a two-factor mixed design

with pretest-posttest control groups. The research design is also a mixed design relevant and irrelevant

in itself. Since the participants were measured with respect to the dependent variable before and after

the experimental implementation, it has a relevant pattern; since the measurements of the control groups

made up of different subjects were compared to each other, it has an irrelevant pattern [16]. The

population of the study was composed of all nursing students in their third year studying for their

bachelor's degree in a state university (N = 119). Nursing students in their first year were excluded from

the study because they are not allowed to perform an invasive intervention, nursing students in their

second year were excluded from the study since their professional skills have not reached the desired

level. In the third year, the course of pediatric nursing is offered. Within the scope of this course

implementation, ME / M likelihood increased since procedures to be conducted on groups of infants

were in the forefront. It was assumed that the ME / M tendency and attitude of the participants to stay

with the group bearing risk had diversified over time since there were pediatric patients. A power

analysis was implemented through G-power, and the appointment of individuals to be included in the

groups was determined via research randomizer.

2.2. Inclusion criteria for volunteers to be included in the study

Being a nursing student in the third year, having WhatsApp / Messenger application that is

accessible, being in the procedure of pediatric nursing, not having any language barriers

Collection of Data: The minimum sampling size to be attained in accordance with the results of G-

power analysis is 51 individuals. For the purpose of increasing the representation ability of the sampling

for the population, an extra %20 of the minimum sampling size was included in the study and the study

was completed with 60 individuals. The number of groups in the research was designed to be three. Two

of the groups were the intervention groups, and one of them was the control group (CG). The

intervention groups were the Face-to-Face Education Group (FFEG) and the Information Technology

Group (ITG). The simple random sampling method regarded [17] as valid and the best way of the

selection of the representative sampling was used in the selection of the study groups. Groups, as

specified below, were formed through Research Randomizer on the basis of a class list of 119

individuals. FFEG: 118., 117., 116., 111., 102., 92., 75., 74., 73., 66., 58., 57., 55., 52., 44., 34., 11.,

10., 7., and 1. individuals ITG: 115., 114., 107., 105., 101., 93., 90., 88., 71., 68., 67., 63., 62., 48., 39.,

32., 28., 24., 19., and 9. individuals CG: 113., 108., 104., 100., 99., 95., 91., 86., 84., 81., 72., 61., 54.,

50., 46., 42., 29., 27., 5., and 3. Individuals. Before hospital implementations were commenced for all

three groups, a pretest was conducted via Medical Error Tendency Scale for Nurses (METSN) and

Medical Error Attitude Scale (MEAS). During the pretest, the participants were told to choose a

nickname for themselves, and the posttest was implemented in accordance with these nicknames. After

hospital implementations were commenced, the required intervention techniques were applied to the

participants: Training made up of three parts were provided to the FFEG regarding ME / M tendency

and attitude on a face-to-face basis. These parts of training included the definition and significance of

ME / M, commonness and history of ME / M, the reasons why it is frequently observed with nurses,

how it can be prevented, duties, authorizations, and responsibilities in preventing ME / M, the state of

ME / M in legal terms and what sanctions could be imposed. One part of the training was given by an

expert nurse specialized in the field of occupational health and safety (in malpractice in particular); the

Int. J. of Health Serv. Res. and Policy (2020) 5(2):111-122

114

other parts were provided by a faculty member in the field of pediatric nursing and by a faculty member

that provided the course of occupational fundamentals and technique. The same tests were re-

administered as post-tests to all three groups at the end of four weeks. The materials of training were

sent to the ITG through WhatsApp / Messenger in the form of PowerPoint presentations three times (for

three weeks in total with a different subject for each week). It was ensured that the content of the training

was the same as that of the training given to FFEG in order to prevent confusing impact. Whether the

participants studied the presentation was determined and reinforced by the participants giving feedback

through WhatsApp / Messenger. No interventions were made on the control group. The method of triple

blinding was used in the study. Through this method, it was ensured that the participants, the narrator

and the one implementing data entry and analysis did not know who was in which group.

Ethical Statement: All procedures performed in studies involving human participants were in

accordance with the ethical standards of the institutional and/or national research committee and with

the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study is

approved by Bingöl University Ethics Committee ( 92342550/044; 19.06.2019)

2.3. Database Analysis

The situations of the participants researched in their form of individual identificatory

characteristics comprised the independent variables of the study, and the questions measuring METSN

and MEAS comprised the dependent variable of the study. Statistical Package for the Social Sciences-

22 program was used for the analyses. In statistical evaluations, number and percentage, values , and

rank averages are given. Before normality analyzes, missing data and extreme value extractions were

made. Then, histogram drawings were made for compliance with normal distribution, skewness, and

kurtosis values were examined, and Kolmogorov-Smirnov analyzes were performed. Logarithmic

transformations were applied since the data did not show normal distribution. However, it was observed

that the total and sub-dimension scores of the scales did not fit the normal distribution. For this reason,

non-parametric tests [Mann Whitney U (MWU) and Kruskall Wallis (KW)] were used in the research.

The averages were provided with standard deviations; p<0.05 was regarded as the significance level.

2.4. Tests Used in the Study

Individual Information Form: It was produced by the researchers, and it was for determining the

properties of the participants such as age, gender, habits, chronic illness, the place where s/he spent

her/his life over a long period of time, her / his perception regarding her/his income, her/his preference

of the profession and her/his state of satisfaction with the job, her/his perception of the reason for ME /

M.

METSN: It was developed by Ozata and Altunkan [5] in 2010 for the purpose of measuring ME / M

tendencies of nurses. The scale consists of 49 items. These items and their sub-items include ''

Medication and Transfusion Implementations'' (MTI), ''Falls'' (F), ''Hospital Infections'' (HI), ''Patient

Monitoring / Material Safety'' (PM / MS) and ''Communication'' (C). The scale is a 5-item Likert type.

In the evaluation of the scale, the scoring range was determined as between 49 - 245. It has been stated

that this ratio can also be divided by the count of expressions if desired. It has been demonstrated that

the higher the average score of the scale gets, the tendency of nurses for committing ME gets lower and

that the lower the average score of the scale gets, the tendency of nurses for committing ME gets higher.

It has been specified that the Cronbach's Alpha coefficient of the scale developed is .95.

Int. J. of Health Serv. Res. and Policy (2020) 5(2):111-122

115

MEAS: This scale, developed by Gulec and Intepeler in 2012, has 3 factors. The 1st factor was named

''Medical Error Perception'' (MEP), the 2nd factor was named ''Medical Error Attitude (MEA) and 3rd

factor was named ''Reasons for Medical Error'' (RME). The final version of MEAS is made up of 16

items and it is in the type of five-item Likert. The total scoring range of the scale is between 16 - 80.

Two items on the scale are scored inversely. The cut-point of the scale was determined as 3. ME attitudes

of the staff members getting an average below 3 in the scale are evaluated to be negative, ME attitudes

of those getting 3 and over are evaluated to be positive. While the negative attitude indicates that the

staff members have a low awareness of the significance of ME and error reporting, the positive attitude

shows that there is a high level of awareness among staff members for the significance of medical errors

and error reporting. The scoring and assessment criteria specified for the whole scale are regarded in the

same way also for all sub-items of the scale. The Cronbach's Alpha reliability coefficient implemented

for the purpose of testing internal consistency, one of the reliability indicators of MEAS and its sub-

items, was reported to be 0.75 for the whole scale. As for the reliability coefficients of the internal

consistency of the sub-items of the scale, they were disclosed as 0.74 for MEP item, as 0.62 for MEA

item, as 0.60 for RME item.

3. Results

The mean age of the participants in the study was 22.02 ± 3.33, and %78.3 of them were females

(the rate of female students in the department was %77.6). The rate of those with a chronic illness was

%3.4, the rate of those that spend the majority of their lives in an urban area was %78.3. In this study,

the pretest score from METSN is 217.51 ± 15.14 (177 - 245), the posttest score from METSN is 220.18

± 15.39 (178 - 244), the pretest score from MEAS is 62.71 ± 5.24 (52 - 75), and the posttest score from

MEAS is 64.21 ± 5.18 (52 - 73) when mean ± sd scores are taken into account. The Cronbach's Alpha

value in the pretest from METSN 0.899; it is 0.925 in the posttest from METSN. The Cronbach's Alpha

value in the pretest from MEAS 0.563; it is 0.634 in the posttest from MEAS.

No characteristics of the participants shown in Table 1 such as age group, gender, the place of

the residence occupied over a long period, etc. made a difference regarding the group the participants

were placed in (p > 0.05).

As can be seen in Table 2, a difference was found in the posttest score distributions for MTI, F,

HI, and C sub-items of METSN in terms of the groups of the participants (p < 0.05). In this study, the

posttest value of the sub-item for C, the pretest value of the sub-item of MEP, the posttest median values

of the sub-item for MEA from METSN of the FFEG are higher in such a way to create a difference (p

< 0.05). As for the values for the ITG, the posttest values for sub-items of falls, medication and

transfusion implementations for METSN, the posttest value of the total score from MEAS and the

posttest value of the sub-item for MEA are higher in a way to make a difference (p < 0.05). In the control

group, no difference was found regarding both the total score of the scales used and their scores of sub-

items (p > 0.05). Although it did not create a significant difference in the study (p > 0.05), it was

observed that there was a higher increase in the posttest scores of the participants in ITG in comparison

to their pretest scores from both METSN and MEAS.

Int. J. of Health Serv. Res. and Policy (2020) 5(2):111-122

116

Table 1. Distribution of some characteristics of the participants in accordance with the group they are

placed in (N = 60)

Characteristics

FFEGa (n = 20) ITGb (n = 20) CGc (n = 20)

Test value n %* n %* n %*

Age group

Between 19-21 age

22 and above

13

7

33.3

33.3

15

5

38.5

23.8

11

9

28.2

42.9

χ2 = 1.758

p = 0.41

Gender

Male

Woman

16

4

34.0

30.8

16

4

34.0

30.8

15

5

31.9

38.5

χ2 = 0.196

p = 0.90

Longest living area

Rural area

Urban area

5

15

38.5

31.9

3

17

23.1

36.2

5

15

38.5

31.9

χ2 = 0.786

p = 0.67

Income perception

Enough

Insufficient

13

7

37.1

28.0

9

11

25.7

44.0

13

7

37.1

28.0

χ2 = 2.194

p = 0.334

Do you have a habit of smoking, drinking alcohol, or hookah?

Yes

No

5

15

38.5

31.9

5

15

38.5

31.9

3

17

23.1

36.2

χ2 = 0.786

p = 0.67

Does he have a chronic disease?

Yes

No

0

20

0.0

35.1

2

17

100.0

29.8

0

20

0.0

35.1

χ2 = 4.358

p = 0.11

Is the profession your own choice?

Yes

No

18

2

32.7

40.0

19

1

34.5

20.0

18

2

32.7

40.0

χ2 = 0.436

p = 0.80

Is he happy with his job?

Yes

No

No idea

17

0

3

38.6

0.0

23.0

14

1

5

31.8

33.3

38.5

13

2

5

29.5

66.7

38.5

χ2 = 3.206

p = 0.52

If he made a medical mistake, would he report it?

Yes

No

19

1

32.8

50.0

19

1

32.8

50.0

20

0

34.5

0.0

χ2 = 1.034

p = 0.59

Would he report your friend's ME/M?

Yes

No

18

2

31.6

66.7

19

1

33.3

33.3

20

0

35.1

0.0

χ2 = 2.105

p = 0.34 a Face-to-Face Education Group; b Information Technology Group; c Control group

* The line percentage was regarded.

The state of difference between the total pretest and posttest scores of the participants from

METSN and MEAS and some characteristics of participants is shown in Table 3. According to this, the

pretest score of those deeming their income to be sufficient from MEAS is higher (p < 0.05). In the

study, the posttest score from MEAS was found to be higher in those with a chronic disease and in those

saying that they wouldn't report it if they committed a medical error (p < 0.05).

Int. J. of Health Serv. Res. and Policy (2020) 5(2):111-122

117

Table 2. Distribution of the pretest and posttest scores for METSN and MEAS in total and sub-items

in terms of participants' groups (N=60)

Characteristics

FFEGa (n = 20)

Mean ± SD or Mean

Rank

(Min-Max)

ITGb (n = 20)

Mean ± SD or Mean

Rank

(Min-Max)

CGc (n = 20)

Mean ± SD or Mean

Rank

(Min-Max)

Test

value**

METSNd

Pre-test 222.00 (195.00-245.00) 220.00 (177.00-242.00) 222.00 (181.00-237.00) KW = 3.510,

p = 0.173

Post-test 227.50 (196.00-244.00) 222.00 (178.00-242.00) 222.50 (190.00-237.00) KW = 3.186,

p = 0.203

Test* Z = -0.906, p = 0.365 Z = -1.309, p = 0.191 Z = -0.561, p=0.575

MTId1

Pre-test 85.00 (74.00-90.00) 81.00 (63.00-90.00) 84.00 (57.00-88.00) KW = 1.858,

p = 0.395

Post-test 84.50 (76.00-89.00) 83.00 (68.00-90.00) 83.00 (69.00-90.00) KW = 7.705,

p = 0.201

Test* Z = -0.303, p = 0.762 Z = -2.601, p = 0.009 Z = -0.526, p = 0.599

Fd2

Pre-test 23.00 (15.00-25.00) 21.00 (18.00-25.00) 23.00 (13.00-25.00) KW = 0.762,

p = 0.683

Post-test 23.00 (19.00-25.00) 23.00 (19.00-25.00) 23.00 (17.00-25.00) KW = 6.712,

p = 0.035

Test* Z = -0.635, p = 0.526 Z = -2.071, p = 0.038 Z = -0.088, p = 0.930

HId3

Pre-test

56.50 (48.00-60.00) 54.00 (47.00-59.00) 55.00 (45.00-60.00)

KW = 0.563,

p = 0.755

Post-test 57.00 (48.00-60.00) 55.50 (46.00-60.00) 56.00 (43.00-60.00) KW = 5.981,

p = 0.050

Test* Z = -0.674, p = 0.500 Z = -1.380, p = 0.168 Z = -0.172, p=0.864

PM/MSd4

Pre-test 38.50 (30.00-45.00) 36.00 (27.00-45.00) 39.00 (27.00-45.00) KW = 3.287,

p = 0.193

Post-test 39.50 (32.00-45.00) 38.00 (23.00-44.00) 38.00 (29.00-44.00) KW = 3.874,

p = 0.144

Test* Z = -1.178, p=0.239 Z = -0.618, p=0.537 Z = -0.285, p = 0.775

Cd5

Pre-test 21.50 (5.00-25.00) 24.00 (16.00-25.00) 22.00 (5.00-25.00) KW = 1.137,

p = 0.566

Post-test 24.00 (19.00-25.00) 24.00 (8.00-25.00) 23.00 (12.00-25.00) KW = 10.35,

p = 0.006

Test* Z = -2.545, p = 0.011 Z=-0.929, p = 0.353 Z = -1.575, p=0.115

MEASe

Pre-test 61.80 ± 5.86 61.90 ± 5.37 62.49 ± 4.18 F = 1.674,

p = 0.197

Post-test 64.70 ± 3.97 64.45 ± 5.14 63.50 ± 6.36 F = 0.291,

p = 0.749

Test* t = -1.962, p = 0.065 t =- 3.422, p=0.003 t = 0.836, p = 0.414

MEPe1

Pre-test 6.20 ± 1.36 6.15 ± 1.59 5.80±1.36 F =0 .455,

p = 0.637

Post-test 5.35 ± 1.26 5.95 ± 1.76 5.80±1.39 F = 0.877,

p = 0.421

Test* t = 2.429, p = 0.025 t = 0.940, p = 0.359 t = 0.000, p = 1.000

MEAe2

Pre-test 28.05 ± 3.51 28.85 ± 3.21 29.65 ± 2.77 F = 1.262,

p = 0.291

Post-test 29.90 ± 2.12 30.05 ± 2.35 28.85 ± 2.99 F = 1.349,

p = 0.268

Test** t = -2.325, p = 0.031 t = -2.108, p = 0.049 t = 1.228, p = 0.234

RMEe3

Pre-test 27.55 ± 3.06 26.90 ± 3.00 29.00 ± 3.17 F = 2.428,

p = 0.097

Post-test 29.45 ± 2.87 28.45 ± 3.08 28.85 ± 4.23 F = 0.426,

p = 0.655

Test* t = -2.027, p=0.057 t = -2.153, p = 0.044 t = 0.183, p = 0.857 a Face-to-Face Education Group, b Information Technology Group, c Control group, d Medical Error Tendency Scale for Nurses; d1Medication and Transfusion Implementations', d2Falls, d3Hospital Infections, d4Patient Monitoring/Material Safety, d5Communication; e Medical Error Attitude Scale, e1Medical Error Perception, e2Medical Error Attitude, e3Reasons for Medical Error,

*Paired-Samples T-test / Wilcoxon Signed Ranks test, **One-Way ANOVA / KW: Kruskall Wallis test

Int. J. of Health Serv. Res. and Policy (2020) 5(2):111-122

118

Table 3. Distribution of the pretest and posttest scores of the participants from METSN and MEAS in

terms of some of the participants' characteristics (N=60) Characteristics METSNa Pretest

Mean ± SD /

Mean Rank

METSNa Posttest

Mean ± SD /

Mean Rank

MEASb Pretest

Mean ± SD /

Mean Rank

MEASb Posttest

Mean ± SD /

Mean Rank

Income perception

Enough

Insufficient

31.26

29.44

32.63

27.52

63.91 ± 5.61

61.04 ± 4.24

65.31 ± 4.89

62.68 ± 5.28

Test* U = 411.00,

p = 0.691

U = 363.00,

p = 0.264

t=2.256,

p=0.028

t = 49.336,

p = 0.056

Does he have a chronic disease?

Yes

No

27.75

30.08

34.25

29.85

65.50 ± 4.94

62.66 ± 5.30

72.00 ± 1.41

63.89 ± 5.09

Test* U = 52.50, p = 0.852 U = 48.50, p = 0.731 t = 0.794, p = 0.565 t = 6.720, p = 0.019

If he made a medical mistake, would he report it?

Yes

No

30.53

29.75

30.31

36.00

62.55±5.22

67.50±4.94

64.12±5.25

67.00±0.00

Test* U = 56.50, p = 0.950 U=47.00, p=0.678 t=-1.319, p=0.385 t=-4.175, p=0.001

aMedical Error Tendency Scale for Nurses, bMedical Error Attitude Scale, *t: Independent Samples T-

test/U: Mann-Whitney U Test, F: One-Way ANOVA

The relationship between the total pretest and posttest scores of the participants from METSN

and MEAS is shown in Table 4. a positive, moderate relationship was found between the pretest and

posttest scores from both scales (p < 0.05).

Table 4. The Relationship between the total pretest and posttest scores of participants from METSN

and MEAS (N=60) *

METSNa

Pretest

METSNa

Posttest

MEASb

Pretest

MEASb

Posttest

METSN Pretest Rho 1

p -

METSN Posttest Rho 0.437** 1

p 0.001 -

MEAS Pretest Rho -0.133 -0.172 1

p 0.310 0.190 -

MEAS Posttest Rho -0.069 0.023 0.472** 1

p 0.601 0.859 0.001 -

a Medical Error Tendency Scale for Nurses, b Medical Error Attitude Scale

* Spearman correlation analysis was implemented.

Int. J. of Health Serv. Res. and Policy (2020) 5(2):111-122

119

4. Discussion

There were two objectives in this study with a pretest-posttest comparison and with the

randomized-controlled trial method, the first of which was to determine whether any difference emerged

between participants' scores from METSN and MEAS in terms of the methods employed in the

intervention. The second objective of the study was to determine whether the desired characteristics

created any difference in the scores from METSN and MEAS. The result that primarily attracts attention

in the study is the attitudes of the participants regarding the reasons for ME / M. The participants

specified among the top three reasons inexperience in the hospital, stress, and lack of knowledge, and

they indicated among the lowest three reasons the long periods of working and presence of excessive

protocols-procedures regarding implementations/incomprehensibility of protocols-procedures, not

paying attention to shift changes and dissatisfaction with the administrator. In the study carried out by

In the literature, while excessive workload, exhaustion and lack of communication were found to be the

reasons that most cause ME / M; absence of on-the-job training, dislike-negligence of the profession

and administrative problems were reported to be the last three reasons that cause ME / M [18-21].

The second conclusion of the study is that the methods employed in intervention do not make a

difference in the total scores from METSN and MEAS. However, it was observed that a difference

emerged in scores in the items of communication, ME perception, and ME attitude in the face-to-face

education group. It was found that a difference emerged in the sub-items of medication and transfusion

implementations, falls, the total score from MEAS, and MEA sub-dimensions in the group where

Whatsapp and Messenger were used as the information technology. On the other hand, the situation

regarded as significant is the excess of the proportional increase in the posttest scores of the participants

in ITG from METSN and MEAS. In a study by Sezer et al where whether online and traditional methods

create any difference in on-the-job training is assessed, it was reported that the posttest scores of the

intervention group rose in a similar way to those in this study [22]. In one study, 500 obstetricians and

500 pediatricians were asked whether they gave any recommendation to their patients regarding the

consumption of chicken products. This study not only reveals the impact of traditional communication

tools once again but also the fact that doctors have been opting for the Internet and social media tools in

getting information and that they regard these tools as important references with respect to treatment

options [23].

The third result of the study is that among the desired characteristics, perception of income level,

the state of chronic illness, and variables regarding reporting of ME/M in case of the commitment of

these create a difference in terms of METSN and MEAS. Socio-demographic characteristics assessed

in the study conducted by Guven et al [24]. Through cooperation with volunteering nurses working in a

state hospital did not create any difference in terms of ME / M attitude. In the study by Ozen et al., the

score averages in those at the age of 31 and over and in women from METSN were found to be high

enough to create a difference [18]. In another study was reported that total score averages and the score

averages from some sub-items from METSN were higher in women, in those that deemed their income

to be insufficient and in those dissatisfied with their jobs [25]. The reason for the differences has been

considered to be the fact that the sampling group was working.

The last finding of the study is the result of intervention methods for pretest and posttest scores.

It was observed that the score values of the participants regarding ME / M tendencies and attitudes after

the interventions implemented increased positively and moderately. This situation has been interpreted

Int. J. of Health Serv. Res. and Policy (2020) 5(2):111-122

120

in such a way that it is thought that updates and reinforcements of information for individuals to increase

ME/M tendency and attitude are beneficial. The use of web-based networks has been explained as

pedagogical tools in the literature and it has been stated that the educational use of such tools will be

beneficial [26-28]. The finding that comes before us in observations in our day regarding this age group

is that the source of information for those that continue their daily lives in the allure of social media is

now the digital world. Therefore, the result is attention-grabbing. It is deemed that the awareness-raising

regarding health education or implementations rendered in general through information technologies

will be convenient.

5. Conclusions

In this study where whether face-to-face education methods and methods of education through

information technologies make a difference in ME/M tendency and attitude was assessed, and it was

found that there was no difference between both intervention methods in terms of efficiency. ME / M

tendency decreased and levels of positive attitude increased after both intervention methods. None of

the socio-demographic characteristics made a difference in the total scores for tendency and attitude;

however, some of them made a difference in sub-item scores. It will be beneficial to re-conduct this

study both on other samples and in various disciplines providing health services.

Ethical Statement: All procedures performed in studies involving human participants were in

accordance with the ethical standards of the institutional and/or national research committee and with

the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This study is approved by Bingöl University Ethics Committee ( 92342550/044;19.06.2019).

Funding sources: The work did not receive any other grant from funding agencies in the public,

commercial, or not-for-profit sectors.

Declaration of Conflict Interest: The authors declare no further conflicts of interest. For any conflicts

of interest outside the submitted work, all authors filled in the ICMJE form that is available upon request.

Acknowledgments: We thank all of the participants.

References

[1] Merriam Webster, Malpractise definition. https://www.merriam-

webster.com/dictionary/malpractice.

[2] JCAHO, 2006. Sentinel Event Statistics, Retrieved from www.jointcommission.org/Library/TM

physicians/mp _11_06.htm

[3] Avsar, G., Atabek Armutcu, E., Karaman Ozlu, Z., “Determining the level of tendency in

malpractice of nurses: A hospital sample”, HSP, 3(2), 115-122, 2016. doi 10.17681/hsp.86420

[4] Akgun Sahin, Z., Kardas Ozdemir, F., “Examination of the tendency for nursing malpractice and

affecting factors”, HEAD. 12(3), 210-214, 2015. doi 10.5222/HEAD.2015.210

[5] Ozata, M., Altunkan, H., “Frequency of medical errors in hospitals, determination of medical

error types and medical errors: Konya sample”, Journal of Medical Research, 8(2), 100-111,

2010. https://www.medikalakademi.com.tr/?get_group_doc=20/1460364096-hastane-tibbi-

hata.pdf

Int. J. of Health Serv. Res. and Policy (2020) 5(2):111-122

121

[6] Kırsan, M., Akın Korhan, E, Simsek, S., Ozciftci, S., Ceylan B. “Medication errors in Nursing

practice: A sysytematic Review”, Turkiye Klinikleri J Nurs Sci, 11(1),35-51, 2019. doi

10.5336/nurses.2018-62052

[7] Kahriman, I., Ozturk, H. “Evaluating medical errors made by nurses during their diagnosis,

treatment and care practices”, J Clin Nurs. 25(19-20), 2884-24, 2016. doi 10.1111/jocn.13341

[8] Joon, L.M., Yeon, L.M., Won, M.H. “Nurses’ perception of nursing malpractice liability

insurance”, Indian Journal of Health Research & Development, 10(11), 4481-4486, 2019. doi:

10.5958/0976-5506.2019.04313.4

[9] Menachemi, N., Shewchuk, R.M., O’Connor, S.J., Berner, E.S., Allison, J.J., “Perceptions of

medical errors by internal medicine residents: Development and validation of a new scale”,

Quality Management in Health Care, 14(3), 144- 154, 2005.

https://www.ncbi.nlm.nih.gov/pubmed/16027592

[10] World Health Organization 2019. World Alliance for Patient Safety Forward Programme 2005.

Retrieved from http://www. who.int/patientsafety/en/brochure_final. pdf

[11] Akalın, H.E., “Patient safety in intensive care units”, Journal of Intensive Care, 5(3), 141-146,

2005. http://www.yogunbakimdergisi.org/managete/fu_folder/2005-03/2005-5-3-141-146.pdf

[12] Ozer, O., Tastan Set, T., Cayır, Y., Sener, M.T., "Malpractice", Dicle Medical Journal, 42(3),

394-397, 2015. doi 10.5798/diclemedj.0921.2015.03.0597

[13] Moo, 2019. Sharing and Communication Infographic. Retrieved from

https://www.moo.com/us/partner/sharing-and-communication/

[14] Ugwu, L.O., Oyebisi, T.O., Ilori, M.O., Adagunodo, E.R., “Organizational impact of information

technology on the banking and insurance sector in Nigeria”, Technovation, 20(12), 711-721,

2000. doi 10.1016/S0166-4972(00)00013-4

[15] Plano Clark, V.L., Creswell, J.W., Understanding Research: A consumer’s guide. Upper Saddle

River, NJ: Pearson Education. 2015.

[16] Buyukozturk, S., Kılıc Cakmak, E., Akgun, O.E., Karadeniz, S., Demirel, F., Scientific Research

Methods, Ankara: Pegem.2011

[17] Arıkan, R., Research Methods and Techniques, Ankara: Nobel. 2013.

[18] Ozen, N., Onay, T., Terzioglu, F., “Determination of nurses' tendency to make medical errors and

affecting factors”, Journal of Health Sciences and Professions, 283-292, 2019. doi

10.17681/hsp.451510

[19] Cevik Durmaz, Y., Dogan, R., “Malpractice tendency of nursing students at a public university”,

Urkish Studies. 15(2), 853-864, 2020 864. https://dx.doi.org/10.29228/TurkishStudies.37030

[20] Birgili, F., Sahin, M. “Determination of nursing students’ medical errors”, International Journal

of Nursing, 6(1), 25-32,2019.doi: 10.15640/ijn.v6n1a4

Int. J. of Health Serv. Res. and Policy (2020) 5(2):111-122

122

[21] Ozturk H., Kahriman, İ., Bahcecik, A.N., Sökmen, S., Calbayram, N., Altundag S, Kucuk, S.

“The malpractices of student nurses in clinical practice in Turkey and their causes”, J Pak med

Assoc. 67(8), 1198-1205, 2017.

[22] Sezer, B., Karaoglan Yılmaz, F.G., Yılmaz, R., “Comparison of online and traditional face-to-

face in-service training practices: An experimental study”, Journal of Cukurova University

Faculty of Education, 46(1), 264-288, 2017. doi 10.14812/cuefd.311737

[23] Bir, A.A., Doctors' Information Source Is Also Popular Media!. Health Communication

Association. 2019. Retrieved from http://saglikiletisimi.org/doktorlarin-bilgi-kaynagi-da-

populermedya

[24] Guven, S.D., Sahan, S., Unsal, A., “Nurses' attitudes for medical errors”, İzlek Academic Journal,

2(2), 75-85, 2019. https://dergipark.org.tr/tr/download/article-file/799882

[25] Yigitbas, C., Oguzhan, H., Tercan, B., Bulut, A., Bulut, A., “Nurses’ Perception, Attitudes and

Behaviors Concerning Malpractice”, Anadolu Klinigi 21(3), 207-214, 2016.

https://dergipark.org.tr/tr/download/article-file/310310

[26] Albion, P.R., “Web 2.0 in teacher education: Two Imperatives for Action, Computers in the

Schools”, Journal Computers in the Schools, 25(3-4), 181-198, 2008.

doi.org/10.1080/07380560802368173

[27] Ferdig, R.E., “Editorial: Examining social software in teacher education”, Journal of Technology

and Teacher Education, 15(1), 5-10, 2007. http://www.editlib.org/p/23518

[28] McLoughlin, C., Lee, J.W., Social Software and Participatory Learning: Pedagogical Choices

with Technology Affordances in the Web 2.0 Era. 2008. Singapore. Retrieved from

https://pdfs.semanticscholar.org/52ac/3f2b3d75e6de176dce701afc0b469d7f949a.pdf